What it says about your culture, leadership, and how people really feel at work
By Greg Ikner, President | The AGA Group™
The High Cost of Unused PTO
If paid time off is a benefit… why don’t more employees use it?
Every year, millions of vacation days go unused. According to the U.S. Travel Association, over 55% of American workers don’t use all their paid time off each year.. And it’s not just a fluke—it’s a pattern. At The AGA Group™, we talk with candidates and hiring managers across healthcare and life sciences, and this comes up more often than you’d expect.
PTO is available. Schedules allow it. But people still hesitate to take it.
So… what’s really going on?
Why Unused PTO Is a Sign of Deeper Culture Issues
On paper, companies offer generous PTO. But in practice? Many professionals either don’t feel comfortable using it—or feel punished for doing so.
The reasons vary, but they tend to fall into the same few categories:
- Fear of judgment. No one says it out loud, but employees often feel they’ll be seen as less committed if they step away.
- Workload pressure. It’s hard to unplug when you know the work will pile up—or your absence creates stress for the rest of the team.
- No coverage plan. Many teams are already stretched thin. Taking time off just doesn’t seem realistic.
- Cultural signals. If leadership never takes vacation, or if PTO is viewed as “optional,” people get the message.
These aren’t surface-level excuses. They’re real, emotional barriers. And for many employees, especially in healthcare, taking time off feels like a risk.
But Here’s the Catch: Not Taking Time Off Comes at a Cost
According to Zippia, in 2022, more than half of Americans (55%) didn’t use all of their paid time off, compared to (27.2%) of PTO that went unused in 2018. When unused PTO piles up, the problems don’t show up all at once. They sneak in over time.
You start to notice:
- More fatigue, fewer ideas
- A dip in energy or enthusiasm
- People getting sick more often
- A team that’s present—but disengaged
And if you’re in healthcare, this isn’t just a team issue—it’s a patient care issue. Burned-out staff deliver burned-out care. That’s not sustainable.
So What’s the Fix?
We don’t fix this with more policies. We fix it with leadership and planning.
Start with your own behavior. Do you take your PTO? Do your managers unplug fully? When someone on your team plans a vacation, do they get support—or side-eye?
Here’s what high-trust, high-retention teams do differently:
They talk about PTO like it’s normal.
They plan for it like it’s essential.
And they encourage it like it matters—because it does.
Here’s how that looks in practice:
- Normalize it out loud. Don’t just approve time off. Say, “I hope you take the time you need—and enjoy it.”
- Create true coverage. Cross-train staff. Partner with a staffing firm (like ours). Plan ahead so no one feels they have to choose between rest and responsibility.
- Model it. Take your own time off. Then log out. Really log out. It sets the tone more than any policy ever could.
What’s at Stake?
Unused PTO is more than just a number on a spreadsheet.
It’s a signal—that your team is tired, hesitant, or unsure they’re safe to rest.
If you want to keep your best people, give them a culture that encourages them to breathe.
Because a team that never stops… eventually breaks.
Let’s Make This a Conversation
I’d love to hear from you:
👉 What keeps people from using their PTO?
- I’m worried how it looks
- My workload is too heavy
- There’s no one to cover for me
- I use all of mine
Drop your vote or share your story in the comments. It’s time we talk about this—openly.
Closing Thought
Time off isn’t a luxury. It’s part of the job. And as leaders, it’s our job to make sure people feel safe enough to take it.
At The AGA Group™, we help healthcare organizations create staffing strategies that actually make time off possible. Whether it’s temp-to-perm support, float pools, or executive recruiting—we’re here to build teams that work without burning out.
